Bushfield, Stacey Jane
Evaluating human capital investments in public services: the case of clinical leadership development in NHS Scotland.
PhD thesis, University of Glasgow.
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Clinical leadership, along with other means such as whole system working and multi-disciplinary teams, has been promoted as an important method of engaging clinicians in reform and improving the efficiency and effectiveness of healthcare. Consequently, a key human resource strategy within NHS Scotland has been to invest in training and development to build clinical leadership capacity across the organisation. However, clinical leadership is a contested concept, with no readily accepted definition and is subject to debate between competing professional and managerial logics and identities. As such there has been little investigation into how clinical leaders’ identities are developed at an individual, relational and collective level, how such identity construction affects the development of clinical leaders, and how learning from such development can be transferred back into healthcare organisations. Thus, this thesis investigates the impact that development programmes can have on participants’ identities, through their human capital and social capital, and the organisational factors that influence the degree of learning transfer.
Focusing on a phenomenological case study of an eighteen-month ‘flagship’ leadership development programme for senior clinical leaders across NHS Scotland, the thesis explores the notion of development programmes as ‘identity workspaces’ (Petriglieri, 2011) where participants can step back from their daily routines to reflect and work on their identities and examines whether such workspaces are seen as useful by participants and their managers. Data were gathered through semi-structured interviews, observation of key events and analysis of relevant policy, programme and participant documents. The longitudinal study, undertaken between December 2008 and May 2011, examines the processes, practices, and tensions underpinning leader and leadership identity development. It highlights the importance of studying not only how identities are constructed, maintained and regulated, but also how past identities are deconstructed and unlearned, and the emotional and psychological effects that these processes can have on clinicians.
These data supported the view that identities are formed within social and discursive contexts and evolve and change over time in relation to an individual’s experiences and changes in the wider environment. They also provided support for the claim that leadership programmes can play an important role in the social construction of a leader’s identity as they initiate bonding, brokering, bridging, and legitimising activities which enhance their social capital and reaffirm their identity at a relational and collective level. However, for this identity to be embedded and sustained over time, individuals require a degree of autonomy to implement change as this both reinforces their own sense of self as a leader and encourages others to act reciprocally. Furthermore, developmental support was seen as necessary by participants to encourage a common understanding of leadership which enables the construction of leadership identities at a relational and collective level. Lastly, by examining how clinicians participating on the programme understood and enacted their dual-role, the thesis explores the diverse meaning attributed to the notion of clinical leadership. It considers the internal and external challenges facing clinical leaders and proposes that it is important for clinical leaders to assume a dual-professional identity that allows them to move from being a clinician to a professional clinical leader who combines clinical and leadership expertise. Thus, the thesis provides a contribution to the relatively limited academic literature on clinical leadership and professional leadership development more generally and adds to research on identity work, social identity theory and intellectual capital. In particular, it emphasises that working on and changing ones’ professional identity is not an easy process as it involves first deconstructing and unlearning past notions, beliefs and behaviours before a new sense of selves can be reconstructed.
The research took place within a dynamic policy context that encompasses recent work on engaging clinicians in leadership, embedding strong clinical governance and accountability, and overcoming the economic challenges facing public services both in Scotland and the UK. The thesis makes a contribution to practice by informing ongoing policy relevant debates on leadership development and the value of clinical leadership as well as other dual-professional identities in the Scottish National Health Service and the Scottish Government.
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